Surgery is Delayed Due to Lack of “Time In” After Time Out

SAN JOSE, CA – OR 12 experienced a three-hour delay for what was supposed to be a 7 am start on a Tuesday morning for an open reduction internal fixation of a tib-fib fracture. After the anesthesiology attending finally arrived in the room late at 0715 (because he was inducing in another room which also had a 7 am start time), the timeout was performed. After the correct patient, DOB, surgery, laterality, surgeon, anesthesiologist, residents, medical students, nurses and scrub techs were identified and agreed upon, anesthesia was induced and the patient was intubated.

“I don’t think she said “Time In yet”

Silence followed. Everyone in the room waited for incision, but nothing happened. “It was strange—everyone was staring at me like they didn’t understand why I wasn’t starting the case”, says Dr. Harry Reff, a new surgeon at City Hospital. “The RN said “time out,” which seemed reasonable, even if a bit weird of a thing to say in an operating room. But she never said, “time in,” so I figured I should wait, not wanting to go against hospital protocol.”

In the meantime, the residents and medical students stood silently with wet hands in the air, waiting respectfully to gown and glove only after the surgeon had done so, while the RN and scrub tech repeatedly asked if his instruments were correct, if he would like a new pair of gloves or a different gown, or if he required any additional equipment.

The surgical staff and anesthesia record has changed their policy to now include “time in”, which is said audibly and clearly by the surgeon instead of “incision” and is reflected in the medical record.